Decades of Face: The Twenties, The Perfection Decade

Doreen Wu (00:00):
Welcome to another episode of Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your cohost, Doreen Wu. I'm excited to be here with Dr. Lawrence Bass Park Avenue plastic surgeon educator and technology innovator. The title of today's episode is Decades of Face: the Twenties, the Perfection Decade. I'm excited to kick off this series, Decades of Face. Tell me Dr. Bass, what is this all about and what can our listeners expect to learn?

Dr. Lawrence Bass (00:33):
Each decade of life has certain typical aging changes and typical treatments that are part of the pattern of aging. Now, different people may hit these milestones at slightly different ages, but the basic patterns and the progression is remarkably consistent. So in this series, we're going to review decade by decade what those changes are and what the modern day treatments are that can help with those changes.

Doreen Wu (01:09):
So will the series tell me what I should be doing at any given decade?

Dr. Lawrence Bass (01:14):
Not necessarily, but it certainly indicates what you should be thinking about and considering. Then you decide how important the issues are to your individual aesthetics and how severe those individual changes have become in your personal appearance.

Doreen Wu (01:33):
That makes sense. So let's get started. The first decade is your twenties. Everyone should still be young, right? They don't really need anything yet. Is that where the name comes from?

Dr. Lawrence Bass (01:43):
Well, yes and no. There are two aspects. I've termed this decade the perfection decade because the main job is protecting the skin from ultraviolet light and other environmental factors to prevent aging from getting started too early, but also because the second set of jobs is taking anything about appearance, not that it has aging changes because you haven't aged yet appreciably, but that may be less harmonious than it could be, or less than ideal skin that is red or breaking out a facial shape that's not ideal. That's your chance to really perfect your appearance. Some of the prevention kind of things or an extension of what's been called rejuvenation, these are aesthetic treatments to support the face before changes start to show lengthening the time before aging changes begin to manifest.

Doreen Wu (02:48):
Now with the rejuvenation movement, does this mean in my twenties I should be getting Botox and fillers like my mother in her forties or fifties?

Dr. Lawrence Bass (02:56):
Not necessarily. The treatments are often done in a modified fashion, less Botox or filler or a different pattern of injection. For example, mini Botox or micro injections may be what's called for. So these are many very tiny injections that are spaced out over the surface of the skin rather than deeper injections to relax the muscles that are causing wrinkles in somebody who's somewhat older. But some people even in their twenties, have very dynamic faces and their muscles are young and strong and may require a lot of medication to obtain good control for a long enough interval. So the treatments really have to be customized to each individual's needs, but it's also important not to overdo things, especially at this early stage. And you know, with things like neuromodulators, Botox, Dysport, Xeomin, Jeuveau, some motion and expression is important on the face just to look normal.

Doreen Wu (04:05):
You said there were two aspects, Dr. Bass, what is the second one?

Dr. Lawrence Bass (04:10):
Protection and rejuvenation, which we've been talking about a little, is about anti-aging, keeping the face looking young. The second main task, as I mentioned, is optimizing the appearance of the youthful face. So this is mostly about skin quality, but also about doing things like harmonizing facial shape or accenting facial shape.

Doreen Wu (04:36):
Let's talk about skin quality first. Can you explain that in a little more detail?

Dr. Lawrence Bass (04:40):
Sure. This is a factor in appearance that has always been part of aesthetic services, but it's getting a lot more attention in a structured fashion. Lately, we all know if we lined up 100 25 year olds, some people would have smoother skin, some rougher skin, or with more visible pores, oilier skin, more or less redness even in the twenties. Pigment irregularities will show more on some faces than others. Blunting. These unwanted features like roughness, redness, pigment, irregularity, are the main skin quality issues for the twenties. Also, most of us think of acne as a teenage problem, but acne vulgaris, the kind of acne seen in young people typically peaks in the mid twenties, not during the teenage years preventing acne outbreaks. And most importantly, cystic acne, which is more likely to lead to scarring, is very important. In fact, the number one diagnosis in most dermatologist office is acne.

Doreen Wu (05:55):
That is pretty surprising. I didn't realize how much improvement might be possible in young skin. So what are some of the approaches to skin quality for people in their twenties?

Dr. Lawrence Bass (06:04):
Well, it's the same thing for everybody later in the game, but applied in a treatment that will address skin that is more metabolically active. In fact, young skin often gives us much more readily what we want, although acne can be a tough thing sometimes to control. So this starts with products like medicated skin products containing retinoids, growth factors or other agents to calm the skin or to improve skin clearance of oil and debris so that there's less breaking out and less redness, energy treatments, needling treatments, and things like superficial fillers and micro Botox are newer things that may help with skin quality in this young age group

Doreen Wu (07:03):
Earlier. In addition to skin quality, you also touched upon accenting facial features. What is the role there for the twenties decade?

Dr. Lawrence Bass (07:12):
Any facial shape which is a little flatter or unbalanced can be boosted with filler. The number one area for this in people in their twenties is lips. This is the most popular filler treatment for all ages and all nations. But cheeks and chin are also very common areas to provide a little more elegance and definition to the face. Even in youth, big changes might be achieved with surgical implants like cheek and chin implants or in severe examples with surgery to the bones of the face. But small harmonizing changes are most commonly performed with injectable fillers. There are a number of fillers with specific FDA indications for different facial features like Restylane Contour for the cheeks, Juvederm Voluma. Radiesse for jawline and Restylane Kysse for lips. Just to list a few examples, this is also an example of how we don't always want a permanent change. Face shape in the twenties is typically fuller, more of a baby face and will empty in the area just under the cheek, what we call the submalar area over the next decade. Being able to tailor the amount of augmentation to complexities like the cheek and chin over time with recurrent filler treatments allows adjustment for the submalar flattening that starts to occur in the later part of this decade of twenties.

Doreen Wu (08:56):
So far we have mainly focused on minimally invasive nonsurgical treatments. In addition to all of these nonsurgical approaches, what are the surgeries that happen frequently in the twenties?

Dr. Lawrence Bass (09:08):
So we were speaking about this submalar area and the deep fat pad in that area is called the buccal fat pad. So this is sometimes reduced in individuals in their twenties who have very chubby cheeks, sort of chipmunk cheeks, and through small incision inside the mouth that's a little over a quarter of an inch, you can tease out some of that fat and get a little definition in that area. The number one surgery in people in their twenties is rhinoplasty because you know, twenties is a good time to create your personal image that the world is going to know you as as an adult for the rest of your life. For that reason, cheek and chin implants not as common as rhinoplasty, but also very common in this age group. We're really focused on the face here, but there are some popular body procedures in the twenties such as breast augmentation and liposuction.

Doreen Wu (10:16):
And last but not least, before we wrap up Dr. Bass, can you share some important takeaways for our listeners about the 20s decade?

Dr. Lawrence Bass (10:23):
Of course, first, look at skin quality issues. Skin quality always has a meaningful impact on appearance. We all know people with good skin and bad skin, and the difference is obvious, and that's true whether you're in your twenties or you're older. It's never too early to protect against ultraviolet, and that's probably the number one job in the twenties. People are active, they're out doing things, but they need to put a limit on how much ultraviolet their skin is getting to prevent premature aging and reduce the risk of skin cancer. So hopefully everyone has been protecting from the sun since early childhood but since the twenties are a point where some obvious aging changes can start to show, especially in fair skinned individuals, the sunscreen is a critical maneuver. In your twenties, a little goes a long way, so you don't need to do too much, but doing nothing will leave you a little busier in your thirties than some of your friends who tried a little harder with their skin while they were still in their twenties. And at this early stage, there's really a lot of variation in what's needed. So work with someone who will actually look at you and customize the options for you and adjust for the the individual needs in this decade. Because, you know, as someone who's 70, they have a little bit of everything. Someone who's 20 may really only have one or two small issues that need just something simple to really help them look their best.

Doreen Wu (12:10):
Thank you Dr. Bass for expanding our knowledge on the subject and shedding some light on the importance of protection, rejuvenation, and skin quality during our twenties. And thank you to our listeners for joining us today for the first episode in our new Decades of Face series. I definitely learned a lot of useful information about the twenties decade, and I hope our listeners gained some pearls of wisdom as well. If there's one thing I'm taking away from this episode, it is the importance of wearing sunscreen every day. If you think of other exciting developments or trends in plastic surgery that you would like us to discuss in upcoming episodes, please reach out by email or Instagram. We'll see you next time. This is Doreen Wu thanking you for joining Dr. Bass and me for this discussion of aging prevention in your twenties. Be sure to tune in next time, and don't forget to subscribe to our podcast to stay up to date with all of the exciting content that is coming your way.

Speaker 3 (13:01):
Thank you for joining us in this episode of the Park Avenue Plastic Surgery Class podcast with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. The commentary in this podcast represents opinion. This podcast does not present medical advice, but rather general information about plastic surgery that does not necessarily relate to the specific conditions of any individual patient. No doctor patient relationship is established by listening to or participating in this podcast. Consult your physician to advise you about your individual healthcare. If you enjoyed this episode, please share it with your friends and be sure to subscribe to our podcast on Apple Podcasts, Google, Spotify, Stitcher, or wherever you listen to podcasts.